Amy E. Latimer

Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being

Study design: Randomized controlled trial of exercise training in persons with spinal cord injury.Objective: The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength, arm ergometry performance, and indices of psychological well-being and quality of life.Setting: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada.Methods: Thirty-four men and women (aged 19–65 years) with traumatic spinal cord injury (C4–L1; ASIA A–D) of 1–24 years duration volunteered to participate, and were randomized into exercise (EX; n=21) and control (CON; n=13) groups. Twenty-three subjects (11 EX; 12 CON) successfully completed the 9-month study. Subjects were assessed for one repetition maximum (1RM) strength, arm ergometry performance, and several indices of quality of life and psychological well-being at baseline, 3, 6, and 9 months.Results: At baseline, there were no significant differences between groups in age, submaximal arm ergometry performance, muscle strength, or psychological well-being. Following training, the EX group had significant increases in submaximal arm ergometry power output (81%; P<0.05), and significant increases in upper body muscle strength (19–34%; P<0.05); no significant changes occurred in CON. Participants in EX reported significantly less pain, stress and depression after training, and scored higher than CON in indices of satisfaction with physical function, level of perceived health and overall quality of life (P<0.05). Exercise adherence (per cent of prescribed sessions attended) in those subjects who completed the 9 months of training was 82.5%.Conclusions: These results demonstrate that long-term twice-weekly exercise training in this population is feasible, and results in significant gains in both physical and psychological well-being.

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

Study design:Longitudinal, prospective within-subject design.Objectives:(1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme.Setting:Hamilton, Ontario, Canada.Methods:A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up.Results:In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external body-weight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function.Conclusion:Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.

Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain

Study design: Follow-up study of seven individuals with spinal cord injury (SCI) who completed a 9-month randomized control trial (RCT) of exercise training.Objective: In a 9-month RCT conducted in our lab, individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life (PQOL), and less stress and pain than a nonexercising control cohort. The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits.Setting: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada.Methods: Five men and two women (age 42.3±3.6 years) with SCI (C5–T12; ASIA A–D 12.7±8.2 years postinjury) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT. Exercise adherence, PQOL, stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline, and at 3, 6 and 9 months during the intervention.Results: There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate (42.7 versus 80.6%, respectively; P<0.01). There was also a significant decrease in PQOL (P<0.05) and a trend for increased pain (P=0.07) and stress (P=0.12), at follow-up compared to the end of the 9-month trial. Finally, there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period (r=−0.91; P<0.01).Conclusions: These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI.

Physical activity guidelines and guides for Canadians: facts and future.

This article summarizes the main findings from the papers included in this journal supplement. It consolidates the evidence currently available to inform and advance the development of physical activity guidelines for Canadians, and it highlights the specific needs of various population subgroups. The challenges of translating guideline information into effective and persuasive physical activity messages, of campaigns to disseminate messages, and of related evaluations are underlined. Recommendations on how to proceed are based on the evidence base provided by this series of papers; the immediate next steps mandated by this initiative are outlined and priorities for future research are indicated.

Activities of daily living performed by individuals with SCI: relationships with physical fitness and leisure time physical activity.

Study Design:Cross-sectional.Objectives:To examine patterns of participation in activities of daily living (ADL) and fitness-related factors associated with these patterns among individuals with spinal cord injury (SCI).Setting:Centre for Health Promotion and Rehabilitation at McMaster University, School of Kinesiology and Health Studies at Queens University.Methods:Forty-eight participants completed the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) and a fitness test assessing cardiovascular fitness (VO2max and peak power output (Po)). The most commonly reported ADL were extracted from the PARA-SCI data for analysis.Results:Women tended to spend more time participating in domestic and personal care ADL than men. Compared to individuals with tetraplegia, individuals with paraplegia tended to spend more time transferring, cleaning and preparing food and less time wheeling, toileting and dressing. Fitness and participation in leisure time physical activity (LTPA) were associated with certain ADL. Participants with higher levels of fitness spent more time partaking in ADL wheeling and cleaning. Moreover, greater time spent participating in moderate- and heavy-intensity LTPA was positively correlated with time spent engaged in certain ADL.Conclusion:By identifying common ADL performed by individuals with SCI, the study findings begin to provide direction for developing strategies to optimize ADL participation. Future research should examine fitness as a way to help individuals with SCI optimize their ADL participation.

The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury

Study Design:Pre-test, post-test study of the relationship between exercise-related changes in feeling states and pain among persons with chronic incomplete spinal cord injury (SCI) who performed three separate exercise sessions consisting of body-weight supported treadmill training (BWSTT).Objectives:To determine whether exercise-related changes in feeling states are related to exercise-related changes in pain and in-task pain.Setting:Hamilton, Ontario, Canada.Methods:A total of 14 men and women with chronic, incomplete SCI (ASIA B and C) performed three exercise sessions of BWSTT. Measures of pain and feeling states were administered before and after each session along with a measure of pain experienced while exercising.Results:Participants who experienced greater decreases in pain from pre- to post-exercise also experienced greater improvements in feeling states. Pain experienced during exercise was unrelated to changes in feeling states.Conclusion:Among persons with SCI, exercise-related changes in pain can influence the effects of individual exercise bouts on feeling states.

Secondary complications and subjective well-being in individuals with chronic spinal cord injury: associations with self-reported adiposity

Study design:This is a cross-sectional study.Objectives:To examine the associations between adiposity, secondary complications and subjective well-being (SWB) in individuals with spinal cord injury (SCI).Setting:Parkwood Hospital (London); Hamilton Health Sciences-Chedoke Site and McMaster University (Hamilton); Toronto Rehabilitation Institute, Lyndhurst Centre (Toronto); and St Marys of the Lake Hospital and Queens University (Kingston), Ontario, Canada.Methods:A total of 531 men and 164 women (N=695) enrolled in the Study of Health and Activity in People with Spinal Cord Injury (SHAPE-SCI) completed the Secondary Health Complications Survey, SF-36 pain subscale, Satisfaction with Life Scale (SWLS) and the Patient Health Questionnaire-9 (PHQ) during a telephone interview. Body mass index (BMI) measurements were obtained from a subsample of the SHAPE-SCI participants (n=73) during a home visit.Results:Controlling for covariates, individuals who reported being overweight were more likely to have a history of overuse injuries and fatigue, experienced a greater impact of overuse injuries and fatigue, had greater pain and depressive symptoms, and had lower satisfaction with life than individuals who did not report being overweight. BMI was only associated with an increased likelihood of reporting spasticity.Conclusion:Self-reported overweight status was associated with an increased prevalence of certain secondary complications and lower SWB. Future prospective studies should examine whether reductions in adiposity are associated with changes in the prevalence and the impact of secondary complications and SWB.